Primum non nocere: story

In my previous post, I shared that I was having trouble sympathizing with the patients on my psychiatry rotation. I couldn't connect with them for some reason. It wasn't a doctor-patient relationship. It was just a doctor and a patient. Most of the times these patients are addicts or homeless or suffer from some psyciatric condition caused by the long term abuse of drugs. Yesterday was the first time on psychiatry that I've felt like an alliance was established between me and a patient.

I'm going to call her Pieces because she is such a broken young woman. I feel so much sorrow for her. This poor girl is suicidal, homicidal, and depressed. She doesn't trust herself at home alone. She is afraid she is going to kill herself if she is ever left by herself. And I believe her.

Let me to tell you a little about her story.

Pieces was raped by her brother throughout her childhood, starting before age 10 up until her preteen years. Her parents split up when she was in junior high. Her dad said some pretty hard words to her the last time that they spoke. She blames herself for all that happened. She feels that no one in her family was ever happy with her no matter how hard she tried to please them, so she quit trying. She felt she had no value and was worthless as a daughter, sister, and friend. She was raised in a Christian home, so she says. They occasionally went to church. She never thought it was important to her parents because they never made it a priority. So when she was hurting she turned elsewhere. She started drinking and smoking in her early, early teenage years to ease the pain of rejection and to try to find a place to fit in, a place where she could feel valued. She went to partied, drank, did drugs. She lived hard. She got kicked out of high school within a few months of graduation. She was arrested twice at school for fighting and threatening people. She spent some time in a detention center for that. She told me she hasn't been able to get her GED. Because of that, she can't find a decent job. She works at a local fast food restaurant one day a week-hardly enough to live on. Her mother put her out. Her father lives far off. Her sister won't let her live with her because of her anger and impulsive issues. She doesn't have a place to live. So, she lives with her girlfriend(She doesn't trust men for the obvious reasons, so she engages in relationships with other women). Pieces drinks. Smokes. Gets high. Explodes in fits of rage. Attacks others. Harms herself. She does things and says things without thinking about the consequences. She is selfish. She does what she wants when she wants. She is broken.

She does what she has to in order to get what she wants when she wants it without worrying about how it effects others or herself. She is a product of her environment. That is the way the people acted around her growing up. Her brother raped her because he wanted sex-He didn't care how it affected her. Her parents split because they wanted to-They didn't care about the kids. Her mom put her out instead of trying a little harder-She didn't want to deal with it anymore.

The years of hard living and lack of encouragement and implementation of self worth from her family and the failures of her life have left her with no hope. She feels like she has nothing to offer this world. She says she feels like killing herself is the right thing to do. If she did that, no one would have to carry the burden of caring for her.

I learned quickly in medical school how to mask my emotions that arise while I'm interviewing patients. You cannot make your patients feel like they are terrible, weird, creepy, or gross. Patients tell doctors some of their deepest darkest secrets. They trust us because they feel we won't judge them. If they do feel like we are judging them, they clam up. We must do what we can to keep our faces neutral to the patient's situation no matter what may be going on inside of our head.

Yesterday was a real test of the face masking skills I've acquired. While talking to Pieces, I had to hide several reactions and emotions. I masked my disgust and disbelief as she told me about the time she almost fed a toddler bleach to teach him a lesson and the fact that she didn't feel bad about those thoughts. I masked my anger as she told me about her brother raping her and her father being so mean to her. I masked my disapproval as she told me about the drugs she uses. I masked the shock on my face as she told me about the plans she had come up with to kill herself and the ways she had previously attempted to do it. I listened to this strange, sad, and horrible story of a life. I masked the pity I felt for her as she told me about her living situation and her family problems.

Strangely enough, although it was hard to mask some of the emotions, I did not judge her in anyway. Maybe that is where I was going wrong the past few weeks. Maybe that is why I wasn't connecting with those patients. Maybe I was judging the patients because I thought it was by their own choices that they were in these situations. I never got to hear their whole story like I did with Pieces.

What opportunities did I miss to minister to these broken and beaten down people? I can be so ignorant in my comfortable life. Who am I to pass judgment on anyone? I am broken just like they are. I am in Pieces as well. God loves Pieces just as much as he loves me. God loves the men in detox at the VA just as much as he loves me. God loves the meth addict in the ER just as much as he loves me. Who am I to judge?

People who live in glass houses should not throw stones...

Romans 14:4
"Who are you to pass judgment on the servant of another? It is before his own master that he stands or falls. And he will be upheld, for the Lord is able to make him stand."

Romans 14:10
"Why do you pass judgment on your brother? Or you, why do you despise your brother? For we will all stand before the judgment seat of God;"

Pictures of Greenville from the Great Flood of 1927: